A depressive episode is a period characterised by low mood in conjunction with other depressive symptoms which last for a minimum of 2 weeks.
Typical symptoms of a depressive episode include:
- depressed mood
- loss of interest and fun
- increased fatigue
Other symptoms include:
- reduced concentration
- reduced self-esteem and self confidence
- thoughts of guilt and unworthiness
- pessimistic views about the future
- ideas or acts of self-harm* and/or suicide
- lack of sleep or too much sleep
- loss of libido
- loss or increase in appetite
- psychomotor retardation and agitation
* self-harm doesn’t necessarily mean that the person is suicidal, however, it may be intensive, possibly leading to death
Mild Depressive Episode = 2 or more typical symptoms + 2 or more other symptoms for at least 2 weeks (non-intense symptoms which eventually stop)
Moderate Depressive Episode = 2 or more typical symptoms + 3 or more other symptoms for at least 2 weeks (person experiences difficulty continuing with social, work or domestic activities)
Severe Depressive Episode = all 3 typical symptoms + 4 or more other symptoms for at least 2 weeks (person is not able to continue with daily activities)
Depressive Episode ICD-10 Reference: https://www.icd10data.com/ICD10CM/Codes/F01-F99/F30-F39/F32-/F32.9
Recurrent Depressive Disorder
Recurrent Depressive Disorder is characterised by the following 3 criteria:
- Current episode should fulfill the criteria for depressive episode
- Include at least 2 episodes lasting a minimum of 2 weeks separated by several months without significant mood disturbance
- May be mild, moderate or severe, with or without psychotic symptoms
Recurrent Depressive Disorder ICD-10 Reference: https://icd.codes/icd10cm/F33
Psychological Treatment
INTERPERSONAL PSYCHOTHERAPY (IPT): short-term psychodynamic therapy focusing on current relationships.
COGNITIVE THERAPY: monitoring and identification of automatic thoughts, followed by replacement of negative thoughts with neutral or positive thoughts.
MINDFULNESS-BASED COGNITIVE THERAPY (MBCT): strategies such as meditation to help prevent relapse.
BEHAVIORAL ACTIVATION THERAPY (BA): increases participation in positive reinforcing activities that help disrupt depression, withdrawal, and avoidance.
BEHAVIORAL COUPLES THERAPY: enhances communication and satisfaction.
Biological Treatments
ElectroConvulsive Therapy (ECT): induces brain seizure and momentary unconsciousness; this method is reserved to individuals who do not respond to treatment.
Transcranial Magnetic Stimulation for Depression (TMS): in this method, which is reserved for those who fail to respond to first antidepressant, an electromagnetic coil is placed against the scalp.
Psychopharmacology for Depressive Episode
Monoamine Oxidase Inhibitors (MAOIs)
- Phenelzine (Nardil); Isocarboxazid (Marplan)
- Not supported as first line anti-depressants due to safety, tolerability, restrictive dietary requirements
- Foods containing Tyramine such as dry, aged, fermented meat, aged cheese, marmite, tap beer, and sauerkraut should be avoided as these can trigger a hypertensive crisis
- A hypertensive crisis is characterised by headaches, nausea, palpitations, vomiting, and sweating
Tricyclic Anti-Depressants
- Amitriptyline (Tryptizol); Clomopromine (Anafranil); Imipramine (Tofranil)
- Usually avoided due to extensive side-effects
- Inhibit serotonin and nor-adrenaline
Selective Serotonin Reuptake Inhibitors (SSRIs)
- Paroxetine (Seroxat); Fluoxetine (Prozac); Fluvaxamine (Faverin)
- First line treatment for depression
- Block the reuptake of serotonin on the pre-synaptic membrane
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
- Vanlafaxine (Effexor); Duloxetine (Cymbalta)
- First line treatment for depression
- Block the reuptake of serotonin and norepinephrine on the pre-synaptic membrane
Nursing Approach to a Depressive Episode
- Value the individual as a person with unique values and beliefs
- Respect personal space
- Reserve time to talk
- Build therapeutic nurse-patient relationship in a non-judgemental way through active listening and simple questioning
- Monitor the person’s physique – ask regarding sleeping pattern, weight fluctuations and fluid status
- Monitor the person’s cognition – ask regarding interaction and conversation with others
- Monitor the person’s behaviour – notice if the person is showing evident signs of self-neglect and psychomotor retardation
- Keep a continuous risk-assessment, including risk of self harm and suicide
Depressive Episode Nursing Care Plan
The following Depressive Episode Nursing Care Plan is based on the situation shown in the above video…
Immediate Goals
- compile full history including current depressive episode and any possible other similar episodes in the past
- compile a list of current medications and other comorbidities to ensure that therapy suggested is suitable for the person
- person should be prescribed psychopharmacological therapy such as SSRIs; to be started immediately
- refer for psychological therapy such as CBT
- ensure person safety especially with regards to suicidality
- ensure that her children are being well cared for; encourage her to seek out help if need be
Short Term Goals
- review medication and see if any changes in dose or type of prescribed drugs need to be adjusted/changed
- educate about compliance to medication and the importance of avoiding any foods if the person has been prescribed MAOIs
- make sure that the person has started to sleep adequately; prescription for sleeping pills should be considered so the person can rest well during the night
- educate the person about the importance of continuing psychological therapy eg. CBT so coping techniques can be learned to avoid relapse or prolonged depressive episode
- encourage nutritional food intake and adequate fluid intake and if need be encourage nutritional support through the help of a nutritionist
- teach the importance of keeping with follow-up appointments
- encourage the person to start investing some time daily of interaction/games with the children, even if it is a couple of minutes, increasing slowly
- encourage social interaction and job retainment/attendance
- encourage the person to restart investing time in her hobbies or pick up new hobbies
- consider suggesting development of a routine including working hours and financial planning
- explore the person’s relationships with family and partner and suggest Behavioral Couples Therapy
Long Term Goals
- re-assess symptoms
- review medication and psychological therapy and their effectiveness
- consider change of treatment if need be
- ensure job retainment
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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